Bacteraemia due to peripheral IV line

Question 1

What are the two most common causes of peripheral IV line sepsis?

Answer 1

S. aureus
Coagulase negative staphylococci
(S. epidermidis, S. saprophyticus)

Question 2

Complications of bacteraemia

Answer 2

Complications
	• Metastatic infection to deep organs:
		○ Spine in adults
		○ Long bone metaphysis in children
		○ Prosthetic joints or devices
Heart valves

Question 3

What are the three main things steps of initial management?

Answer 3

1. ID and remove source of infection i.e. removal of offending IV cannula is essential
   
   2. Blood cultures (at least 2 samples)
2. Empiric antibiotics

Question 4

Outline the empiric antibiotics for peripheral IV line sepsis

Answer 4

• IV 2g flucloxacillin (MSSA) 6 hourly OR vancomycin (determined by prevalence of MRSA in hospital or anaphylactic to penicillin) for 14 days of IV therapy without
○ clinical evidence of infection
○ repeat blood at 72 hours negative and,
○ no signs of metastatic infection (fever, joint pain) PLUS

• IV 420 mg gentamicin (gram negative coverage) daily for maximum of 2 days

Question 5

What is the rationale for 14 days of therapy?

Answer 5

Rationale of 14 days therapy of flucloxacillin: prevent relapse as S. aureus can seed (deep seated infection) and reappear if Rx is ceased to early

Question 6

Define defervescence.

Answer 6

drop T in patient with fever